Dr Knowles and colleagues present foundational epidemiologic research about congenital heart defects.1 Their study demonstrates a dramatic reduction in mortality from congenital heart disease over this 50-year period. The magnitude of reduction in the number of deaths is so great that they chose to use a logarithmic scale in their figures. Their work, which pertains exclusively to improvements in the UK, complements a similar literature from other settings using population-based data from USA,2 Canada3 and other centres in Europe. Their study takes advantage of death data obtained from the Office for National Statistics in England and Wales, as well as other routinely collected population-based data and covers a 50-year time period. Other studies have used a similar methodology over shorter periods or have focused on reductions in infant mortality, surgical survival or survival to adulthood. Taken together, in all settings capable of surgery and other treatments for congenital heart defects, reductions in death have been dramatic and sustained with most patients surviving both early childhood and beyond.

Beyond this dramatic improvement in survival as well as shifts in age at death, …